POS1007-HPR EXPERIENCES OF PARTICIPATION IN GOAL SETTING PRIOR TO RHEUMATIC TEAM REHABILITATION – A JOINT VENTURE
Authors: L. Skovly Nielsen, J. Primdahl, B. Clausen, A. Bremander
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Patient involvement in the goalsetting process and use of shared decisions increases adherence to rehabilitation and support patients' motivation to achieve the goals (1). However, the shared decisions that are essential for goal setting during a rehabilitation process may be compromised by patients' lack of ability to participate actively in setting goals, inadequate skills among health professionals (HPs) to facilitate goal setting and poor organizational conditions such as insufficient time [2]. This study focuses on a Danish multi-professional team rehabilitation context where, over several years, work has been done to improve the prerequisites for goal setting, both by organizational changes and by educating and preparing HPs as well as patients for the goal setting process. <h3>Objectives</h3> To understand how patients with rheumatic musculoskeletal diseases (RMDs) perceive participation in the goal setting process prior to multi-professional team rehabilitation. <h3>Methods</h3> Individual semi-structured interviews were performed with 22 patients (median 49 years, 17 female), who were to be admitted to multi-professional team rehabilitation for patients with RMDs at one of two Danish rehabilitation centres. We applied qualitative content analysis with an inductive approach. All participants had received information about goal setting prior to admission and the team used supportive tools and motivational interviewing to facilitate the goal setting process. <h3>Results</h3> The analysis derived one overarching theme, goal setting was viewed as a <i>joint venture</i> between the patients and the team, where capacities and resources were shared in order to formulate one or more goals. Three sub-themes emerged from the analysis (Table 1): 1) <i>Responsibility during goal setting</i> was experienced as a shared responsibility between the patient and the team, where active involvement in the goal setting process added to patients' feeling of responsibility. For others, goal setting was perceived as a responsibility that solely rested with the team of HPs, who were considered to be the experts. 2) <i>Being dressed for goal setting</i> reflected whether patients felt prepared to take part in goal setting. Written and oral information prior to rehabilitation evoked thoughts on potential goals and previous experiences with rehabilitation made patients feel more qualified for setting goals. Others perceived goal setting as very difficult, partly because it felt like a huge commitment or due to lack of information.3) <i>Being an equal member of the team</i> referred to the interaction with the HPs. Patients felt they were seen as whole persons, and they felt acknowledged and respected. On the other hand, some felt as outsiders and considered HPs as authorities, causing a feeling of nervousness and insecurity related to the validity of the patients' wishes and expectations. <h3>Conclusion</h3> Despite a clinical practice where key areas of importance to successful patient-centred goal setting has been implemented, goal setting is still perceived as a challenge for some patients with RMDs. Future studies should uncover whether the level of health literacy among patients with RMDs bears importance for shared decisions and goal setting prior to rehabilitation. <h3>References</h3> [1]Rose A et al. Shared decision making within goal setting in rehabilitation settings: A systematic review. Patient Educ Couns. 2017;100(1):65-75. [2]Crawford L et al. Facilitators and barriers to patient-centred goal-setting in rehabilitation: A scoping review. Clin Rehabil. 2022;36(12):1694-704. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.